Predictors of Clinical Outcomes in Sexually Abused Adolescents

ABSTRACT

This cross-sectional, case control study examines the association between child sexual abuse and interpersonal and intrapersonal outcomes among 54 adolescents, examining specific clinical measures (depression, anxiety, dissociation, and posttraumatic stress disorder, attachment patterns, self-esteem, self-disclosure, and family environment characteristics). The research results point to a correlation between sexual abuse and higher levels of the clinical measures. In addition, a correlation was found between sexual abuse and level of avoidant attachment, self-esteem, and family environment characteristics. Stepwise hierarchical regressions were conducted to examine how adolescent attributes predicted depression, anxiety, and dissociation beyond the prediction based on sexual abuse. A combination of self-esteem, anxiety attachment, and family cohesiveness made sexual abuse insignificant when predicting levels of depression, anxiety, and dissociation. This study contributes to characterizing the emotional, personal, and family attributes of adolescents who experienced sexual abuse. It also raises questions about the clinical outcomes usually associated with sexual abuse.     

Factors Associated with Adolescents’ Disclosure of Sexual Abuse Experiences in Hong Kong

This research project is the first study conducted in Hong Kong using adolescent subjects to explore predictors of child sexual abuse disclosure. Eight-hundred male and female adolescents aged 13 to 16 years were recruited from the community while another 30 adolescents joined the study from a clinical setting. One hundred and seventy-seven adolescents acknowledged having a child sexual abuse experience. Results showed that the severity of sexual abuse activities and parent attachment were associated with disclosure in the clinical setting, while abuser’s gender and the adolescents’ disclosure tendency were associated with disclosure among participants in the community setting. Among the 104 participants who had disclosed their childhood sexual abuse, 70% of them had disclosed it within one month and 63% of them had disclosed to 2 to 5 people. The majority of the disclosers (81%) shared their child sexual abuse experience(s) with their friends. Participants from the clinical setting tended to reveal the experience more to adults than those from the community. The study suggested that when choosing a potential confidant, adolescents paid more attention to confidant characteristics than to anticipated confidant responses to their disclosure. Limitations and practical implications for increasing child sexual abuse disclosure rates are discussed.     

Perceived Loss of Social Contact and Trauma Symptoms among Adolescents Who Have Experienced Sexual Abuse

ABSTRACT

Child sexual abuse (CSA) is a robust predictor of trauma symptoms. Past research has identified many correlates of trauma symptoms following disclosure of CSA. Theory suggests that loss of social contact may be another important contributor to adolescents’ trauma symptoms following CSA. A clinical sample of 166 adolescents (95% female) between 11 and 19 years (M = 13.80, SD = 1.87) reported on perceived loss of social contact, the extent to which the CSA was coercive, appraisals of self-blame for the abuse, supportiveness of a primary non-abusing caregiver, and trauma symptoms. The adolescent’s relationship to the abuser, abuse severity and duration were coded from forensic interviews. Results indicated that greater perceived loss of social contact was associated with higher levels of trauma symptoms, even after controlling for other correlates of trauma symptoms and demographic variables. These findings suggest that perceived loss of social contact may be an important variable to consider in assessing and intervening with adolescents who have been sexually abused.     

The Effects of Polyvictimization and Quality of Caregiver Attachment on Disclosure of Illegal Sexual Behavior

ABSTRACT

The current study examined the relationship among self-disclosure of illegal sexual behaviors and two conceptually relevant constructs in psychotherapy: childhood polyvictimization (i.e., cumulative types of victimization experienced during childhood) and caregiver attachment. Participants consisted of 63 adolescent males participating in mandated treatment for illegal sexual behavior. Childhood polyvictimization and caregiver attachment were expected to predict self-disclosure of illegal sexual behaviors. Quality of caregiver attachment was also expected to mediate the relationship between polyvictimization and disclosure. Consistent with our main hypothesis, results indicate that quality of caregiver attachment mediated the relationship between childhood polyvictimization and self-disclosure of illegal sexual behaviors in psychotherapy. The current findings highlight the impact of polyvictimization on important therapeutic processes as well as the importance of assessing for multiple types of victimization in adolescents who engage in illegal sexual behavior. Further clinical implications regarding the use of trauma-informed approaches during sex offender treatment are discussed.     

Prevalence of Sexual Trauma History Using Behaviorally Specific Methods of Assessment in First Year College Students

There are several challenges associated with evaluating the prevalence of sexual trauma, including child sexual abuse and adult sexual assault. The aim of this study was to assess sexual trauma prevalence rates among first year college students (N = 954) using behaviorally specific questions and a more representative recruitment sample that did not rely on self-selection. Participants completed a list of sexual trauma questions, including general questions containing labels such as “rape” or “abuse” as well as behaviorally specific questions that describe specific behaviors that qualify as sexual trauma without labels. Results indicated that 6.7% of the sample reported at least one incident of child sexual abuse, with similar rates for men and women. Women were more likely to report a history of adult sexual assault, which was reported by 12.4% of the total sample. Participants were also more likely to endorse a history of sexual trauma when answering behaviorally specific rather than general “label” questions. Women survivors in particular were more likely than men to identify their experiences as abuse/assault (66.7% versus 21.1% for child sexual abuse), which may help explain prevalence differences between men and women in prior research. Men may be less likely than women to label their experiences as abuse and may be underidentified in sexual trauma research without the use of behaviorally specific questions. Overall, the results of this study suggest that the prevalence of sexual trauma is better assessed using behaviorally specific questions and that this is an important topic of study among both men and women.     

Factors Associated with Sexual Dysfunction Symptoms among Veterans who Have Experienced Military Sexual Trauma

Although military sexual trauma (MST) has been found to be associated with sexual dysfunction (SD), there is limited information about the demographic, health, and traumatic experience factors related to SD symptoms among veterans who have experienced MST. The current study surveyed a national sample of 2,002 U.S. veterans who had screened positive for MST. Relationship status, overall health, and antidepressant use were significantly related to the presence of SD symptoms. Analyses examining SD types demonstrated that different factors may contribute to different SD symptoms. Potential implications of these findings for clinical practice and sexual health research among veterans are discussed.     

The mediational effect of affect regulation on the relationship between attachment and internalizing/externalizing behaviors in adolescent males who have sexually offended

Research has shown that adults who sexually offend frequently report perpetrating a sexual offense for the first time during childhood/adolescence; therefore in this preliminary study, we examine the possible covariates related to offending sexually in adolescents. For this study, 62 incarcerated adolescents at a correctional facility in Alabama completed self-report questionnaires regarding demographic information, internalizing/externalizing behavior problems, attachment, and affect regulation. The results of this study indicate that attachment is related to internalizing and externalizing behaviors, as well as, both adaptive affect regulation and maladaptive affect regulation. Through path analyses, this study was the first to test and find that affect regulation ability mediated the relationship between attachment and externalizing behavior; however, it did not mediate the relationship between attachment and internalizing behavior. Interestingly, maladaptive affect regulation appeared to have a stronger influence on problem behaviors than adaptive affect regulation for these adolescents. The findings from this study could help professionals identify more successful therapeutic interventions for these adolescents and consequently prevent later sexual offending and further negative, individual or societal outcomes.     

A review of literature: An examination of the correlation between attachment styles and adolescent girls’ sexual behaviors

ABSTRACT

This literature review examines eight studies of parental attachment styles, sexual behavior, and health outcomes among adolescent girls. The review focuses on studies that analyzed the perceived relationships between parents and their adolescent daughters and whether instabilities of life experiences correlated with risky sexual behaviors and if high-risk sexual behaviors were associated with an increase of sexually transmitted infections, unplanned pregnancies, and other poor health outcomes in adolescent girls. Findings show adolescent girls with insecure parental attachment styles were at a higher risk of sexual behaviors, early pregnancies, and transmission of sexually transmitted infections (STI’s). The most common finding in the studies reviewed was the significant association of how higher parental communication and monitoring may prevent risky sexual behaviors at an earlier age. Recommendations for mental and health care providers include the development of treatment programs to address the importance of parent-attachment relationships and multifaceted health needs of adolescents girls. Programs can be strengthened by involving other family members, improving parent-daughter communication and relationships and emphasizing system-level change (policy, procedure, practice). Adding these elements may ultimately lead to sustained improvements over time. Future research on other family social factors (e.g., divorce and separation of attachment figure, poverty, and single-parent homes) associated with attachment and high-risk behaviors is warranted. More research is needed to exam how secure attachments among adolescent girls may prevent earlier sexual encounters, unplanned pregnancies, and STI’s.     

Persistent Complications of Child Sexual Abuse: Sexually Compulsive Behaviors,Attachment, and Emotions

ABSTRACT

Child sexual abuse has the potential to cause distress for the victim across the lifespan. Romantic relationships may be particularly difficult for victims of child sexual abuse. This retrospective study examined differences in adult romantic attachment, sexually compulsive behaviors, and emotion regulation by history of child sexual abuse in a large, nonclinical sample. Those with a history of child sexual abuse reported more attachment anxiety in romantic relationships and engaged in more sexually compulsive behaviors. Overall, males displayed more sexually compulsive behaviors than females regardless of history of sexual abuse. Males with a history of sexual abuse displayed the greatest number of sexually compulsive behaviors. Surprisingly, no differences were observed in emotion regulation or attachment avoidant behaviors by history of child sexual abuse. Future research should seek to replicate current findings and examine emotion regulation difficulties experienced as a result of trauma.     

Victim's Response Cycle: A Model for Understanding the Incestuous Victim-Offender Relationship

ABSTRACT

The victim-response cycle is a theoretical and clinical model that can be utilized to assist victims in their healing from the trauma of sexual abuse. This model focuses on the specific aspects of the relationship that victims have with their offenders, particularly in incest cases, which contribute to the degree of trauma that victims experience. This relationship can also become the model for other relationships as the victim matures, and the victim-response cycle can be used to assist these adult survivors in understanding their difficulties with adult intimate relationships. This model addresses aspects of attachment and learned coping responses to assist clinicians in treating symptomatic behavior. While severe trauma is rarely treatable with a short-term approach, this model can assist in providing clients and clinicians with tools for symptomatic relief, which may be achievable in a short-term setting. This model has not been examined empirically, but it has been utilized in several outpatient practices in the Midwest with positive clinical results. A case example demonstrating the use of this model is also presented.     

Exploring Gender and Racial/Ethnic Differences in the Effects of Child Sexual Abuse

Child sexual abuse (CSA) has been linked to a number of adverse effects including hypersexuality (HYP), substance use (SUB), suicidality (SUI), and depression (DEP). Despite a plethora of research on CSA, little is known about how it affects adolescents and the cultural factors that influence their coping styles. This study was founded on social-cultural coping theory and the model of traumagenic dynamics of sexual abuse, suggesting that CSA consequences lead to maladaptive coping mechanisms influenced by sociocultural factors. Using archival data, loglinear analysis was conducted to examine gender differences within racial/ethnic groups in HYP, SUI, DEP, and SUB among adolescent survivors of CSA in a National sample of 13,583 male and female high school students. The purpose of the study was to identify differences in the effects of CSA as manifested by variations of maladaptive coping across racial/ethnic groups and gender. Boys were significantly more likely to use substances, while girls were more likely to experience depressive symptoms and suicidality. Notably, this study did not reveal any significant racial/ethnic differences in adolescent coping. These findings can inform treatment planning and interventions for adolescents who may present with DEP, SUI, SUB, or risky sexual behaviors, but may have underlying trauma from CSA. This study contributes to the knowledge base about the processes that take place within adolescent CSA survivors, shedding light on cultural nuances among adolescent coping and informing culturally competent practice.     

Abusing victims: detention of child sexual abuse victims in secure accommodation

Sexually abused children and adolescents, in limbo between revelation of abuse and trial of an alleged offender, or in emotional turmoil after such abuse, need special care and support. Evidence indicates that a number of such children are held in local authority secure centres, on various grounds: to protect them from further sexual assaults by an adult offender; because of their persistent absconding from non-secure residential centres; and because of their disturbed behaviour (including suicidal behaviours), which may have been caused by the assault. Victims of sexual abuse are held with juveniles on remand for serious crimes (including rape and murder), or (because they are too young for youth detention centres) with young adolescents who are held in detention following conviction for such crimes. Evidence is produced from case histories, and from a survey of 15 of the 27 secure detention centres for children and young people in England, that the mix of abused, disturbed and very aggressive children is highly problematic. In worst case scenarios, victims of child sexual abuse are sexually assaulted by juvenile rapists with whom they are housed. © 1998 John Wiley & Sons, Ltd.     

Sexual Abuse in a Classroom of Ten Male Students: A Group Victimization

The term “professional perpetrator” is used to describe individuals who commit sexual abuse in the capacity of a position of trust such as a teacher, household member, or employer. There is an increasing body of evidence focusing on educator sexual abuse in the school environment. However, data are limited about this topic. The aim of this paper is to present the rare occurrence of the case of a male teacher in Turkey who sexually abused his students in an elementary school. Although it is unknown which populations are most vulnerable to sexual abuse, in Turkey we think that the indigenous population is at risk. Abuse cases are not logged into the criminal justice system because the majority of abuse allegations are ignored or disbelieved by families.     

The Relationship Between Perceptions of Response to Disclosure of Childhood Sexual Abuse and Later Outcomes

This study assessed whether perceptions of others’ reactions to disclosure are related to psychological and physical outcomes among individuals with a history of child sexual abuse. Eighty-six female undergraduates completed a series of questionnaires assessing child sexual abuse, nonsexual trauma, depression, anxiety, posttraumatic stress disorder, somatic symptoms, disclosure, and social reactions to disclosure. Those who reported child sexual abuse endorsed higher levels of psychological and physical symptoms than those who reported a nonsexual traumatic event. Child sexual abuse survivors who reported more hurtful responses to disclosure had higher levels of posttraumatic stress disorder, anxiety, and physical symptoms than nonsexual trauma survivors. These findings suggest that many survivors of CSA may need psychological services, and an important focus of treatment may be assessing and strengthening social support.     

Child Support Enforcement and Sexual Activity of Male Adolescents

Strong child support enforcement requires fathers to take financial responsibility for their children and may also encourage more responsible sexual behavior. Using the 1997 – 2001 waves of the 1997 National Longitudinal Survey of Youth (N = 4,272), this article examines the association between child support enforcement and the sexual activity of male adolescents. Stronger child support enforcement was associated with fewer sexual partners, less frequent sexual intercourse, and a higher likelihood of using contraceptive methods among adolescents who had had sexual intercourse in the 12 months preceding data collection. The effects of child support enforcement were particularly strong for non‐White adolescents and those living in high‐poverty areas. These findings suggest that strengthening child support enforcement may be associated with reductions in some aspects of male adolescents’ sexual activity.     

Introduction: Queering Later Life

Summary

The field of sexual trauma developed from the sociopolitical movements of the feminist, rape, and child protection movements. As thinking in the field developed, however, it has been difficult to integrate the perspective of the male survivor of sexual trauma into these perspectives. Gay men, in particular, have been notably absent from the literature, except when their abuse history is discussed as an etiology for their sexuality. It is clear that gay men suffer violence and oppression in the form of homophobia—an abuse with a sexual focus. Integrating the experience of gay men who have suffered trauma into perspectives regarding sexual trauma offers a possibility to enhance understanding about, as well as prevention efforts against, the sexual abuse of children. This includes expanding definitions and vocabulary regarding sexual trauma, as well as recognizing the impact on mental health professionals of working with survivors of sexual trauma.     

Victim to Victimizer: The Psychology of Isomorphism in a Case of a Recidivist Pedophile in Finland

ABSTRACT

An extreme case of a six victim, 38-year-old recidivist sex offender was selected for examining the isomorphic relationships between child sexual abuse trauma and adult sex offenses. This sex offender had victimized children of both sexes and an adult woman. Life history, letter, file, and the Adult Attachment Interview information were analyzed to seek the relations between childhood abuse experiences and adult offending. Both subjective reports and file data revealed that the man had experienced severe physical, psychological, and sexual abuse in childhood. His pattern of sexual offending against children was similar to his own experiences of sexual abuse by his father. The age of the child victims fell in the range of his age at the time of the childhood sexual abuse. Moreover, the use of coercion to gain victim compliance resembled the way his father had acted towards him. The pedophile's offending behavior was interpreted using the isomorphic and attachment perspectives.     

Family Trauma and Dysfunction in Sexually Abused Female Adolescent Psychiatric and Control Groups

Differences in family trauma, stressors, and dysfunction among psychiatric inpatients grouped by sexual abuse self-reports were investigated. Group membership was determined by self-report of adolescents during a structured interview using a modification of the Traumatic Antecedents Scale (TAS). Family trauma/dysfunction was determined from a composite score derived from the TAS. The results indicated a significant difference for family trauma/dysfunction, with sexually abused adolescents reporting more family trauma/dysfunction than psychiatric controls. Also, those abused extrafamilally reported significantly more family trauma and dysfunction than psychiatric controls, while those abused intrafamilially did not report significant differences. Group differences in the endorsement of certain traumas stressors also were investigated. These findings indicated that among psychiatric inpatients, family dysfunction and trauma are present in those extrafamilially abused. Moreover, the extrafamilially abused were significantly different from controls, while incestuously abused were not significantly different. These results are discussed in the context of separation and abuse vulnerability.     

Theoretical Perspectives of Male Sexual Abuse: Conceptualization of a Case Study

The purpose of this article is to demonstrate the traumatic impact that sexual abuse can have on a young male's development by addressing mediating dispositions that can render a child vulnerable to the effects of sexual abuse. Consideration is given to three different theoretical perspectives that are not exclusive to male victims but shed light on the impact that sexual abuse can have on the development of a young boy. These perspectives include early family relationships and attachment theory, developmental psychopathology, and trauma theory. These theoretical lenses provide a conceptual understanding into why some victims are vulnerable to the effects of sexual abuse. Each theoretical view is applied to a case study of an adolescent male with a history of early trauma and sexual abuse. Clinical implications are discussed.